Clinical Analysis Of 98 Patients With Erythrodermic Psoriasis

Erythrodermic psoriasis is a rare severe form of psoriasis, and accounts for 1% of psoriasis. It occurs mostly in adults but rare in children. This disease is difficult to treat, and easy to recur. Erythrodermic psoriasis are generally less stable. The risk for systemic infection and overwhelming sepsis in this form of psoriasis emphasizes the potential life-threatening impact of psoriasis. Objective: 98 cases with erythrodermic psoriasis were retrospectively analyzed to study the precipitating factors, clinical and laboratory findings and treatment of erythrodermic psoriasis. Methods: 1. Case selection: the data from 98 patients with erythrodermic psoriasis at the second hospital of Ji Lin University between January 2000 and January 2005 were included. It was integrated and credible. 2. Diagnostic criterion: According to the diagnostic criterion for erythrodermic psoriasis as described by Clinical Dermatology. 3. Efficacy determinant standard: clinical recovery is appointed to systemic symptoms disappeared and the cutaneous lesions improved 100%~95%. Patients whose systemic symptoms disappeared and erythroderma improved 60%~95% obtained significant effect. Systemic symptoms disappeared mostly and cutaneous lesions improved 20%~59% implied the therapy is effective. Systemic symptoms improved a little and cutaneous lesions improved less than 20% implied the treatment had no effect. The whole effect rate is the sum of recovery rate, significant effect rate and effect rate. 4. Method: 98 cases with erythrodermic psoriasis were retrospectively analyzed. We used rank sum test to analyze the curative effect of various groups, and t-test to analyze the parameters. P<0.05 means marked difference. Results: 1. The base information: the patients included 78 male and 20 female, and the male-female ratio is 3.9:1; the age ranged from 9 to 78 years, and the mean age is 44.9±15.8 years old; the prime type of psoriasis: including 82 cases of psoriasis vulgaris, 6 cases of psoriasis pustulosa, 6 cases of erythrodermic psoriasis, 2 case of psoriasis arthropathica and 2 cases of acute guttate psoriasis; the course of prime psoriasis: ranged from 10 days to 40 years, the average course is 14.3±13.4 years; the age of onset ranged from 8 to 78 years old, and the mean age is 30.4±14.6 years old. Among the 98 patients, the age of 28 cases (28.6%) is younger than 20 years old, 50 cases (51.0%) is between 21 and 40 years old, 16 cases (16.3%) is between 41 and 60 years old, and only 4 cases (4.1%) is older than 60 years old; the onset season: 22 cases in spring, 10 in summer, 18 in autumn and 48 in winter; the course of erythroderma ranged from 3 days to 6 months, the mean is 1 month; the days in hospital is from 7 days to 51 days, the mean is 18.2±9.1 days. 2. The precipitating factors: 36 cases caused by administration of systemic corticosteroids, 26 by taking herbal medicine, 16 by topical therapy during acute course of psoriasis vulgaris, 10 suffered from severe upper respiration tract infection, 4 by heart attack, 2 by taking immunosuppressant (Bimolane), 2 by stress and still 2 could not be determined the cause. 3. Clinical manifestation: ①cutaneous lesions: All the patients presented with diffuse erythema, inflammatory soakage, and scaling. 32 cases presented acute course and 66 subacute course, 6 cases developed mucous membrane damage(two with oral ulcer, four with angular cheititis). ②systemic symptoms: 56 cases with fever, the toppest body temperature is 40.1℃; 32 cases with swollen superficial lymphonodus, among which 22 cases with swollen inguinal lymphnode is account for 68.8% of all cases; 64 cases with edema (particularly of the lower extremities); Nail involvement was observed in 38 cases, including Pitting , ridging and discoloration.; 12 cases with arthralgia. ③complication: including the upper respiration tract infection (18 cases), coronary heart disease (10 cases), anemia (10 cases), diabetes (8 cases), hyperlipidemia (4 cases), chronic bronchitis (4 cases), urethritis (4 cases), femoral head osteonecrosis (2 cases), pneumonia (2 cases), alcohol hepatitis (2 cases), drug hepatitis (2 cases), dermatitis herpetiformis (2 cases) and thrush (2 cases). 4. Laboratory tests: in complete blood count, 38 cases with leukocyte increased, the max count was28.0×109/L; 16 cases with hypochromia(<100g/L); 24 cases with hematuria, 4 albuminuria; 44 cases with Hypoalbuminemia, 46 cases with abnormal liver function, 30 cases with positive HbcAb. 5. Treatment: According to the major medication, the cases were divided into 6 groups coded by A , B, C, D, E, F, using corticosteroids, Acitretin, Stronger Neo-Minophagen C(SNMC), Acitretin+ SNMC, Fibraurea Stem Tablet, corticosteroids+Acitretin/SNMC, respectively. The effect rate of 6 groups is 90.0%, 81.3%, 88.9%, 93.3%, 75.0%, and 100%, respectively. Of the 98 cases, cure rate is 24.5%, significant effect rate is 23.5%, effect rate is 40.8%, and the whole effect rate is 88.8%. The curative effect of Group F is better than that of Group E (P<0.05), and difference in curative effect is not statistically significant between other groups (P >0.05). Difference in curative effect is not statistically significant between acute patients and subacute patients, or between male and female patients (P >0.05). Difference in fever duration and taking effect duration is not statistically significant (P>0.05), but the duration of hospitalization is statistically significant (P <0.05) between the group using...